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Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.100 n.6 Cape Town Jun. 2010

FROM THE EDITOR

A tribute to a journal buff

The South African Medical Journal (SAMJ) was first published in 1884, and has therefore been in existence for 126 years in one form or another. The journal pays tribute to a journal buff who contributed considerably to its more recent history - for some 42 years, or exactly one-third of its existence. Tributes to Ralph Kirsch have been published in the SAMJ,1-3 but we would like to express our appreciation by outlining some of his many contributions to publications in South Africa and to the SAMA stable of journals in particular.

The first record of Ralph's involvement with the SAMJ is an abstract published in 1968, co-authored by his mentors Professors Jack Brock and Stuart Saunders.4 His first full paper in the SAMJ was published in 1972,5 again with Saunders as co-author, but this was preceded by his first full publication, published in Nature in 19686 and co-authored by Frith, Black and Bill Hoffenberg - an enviable jump-start to an illustrious academic career! Of the over 200 full papers that Ralph published over the years, many in the world's most prestigious journals, roughly one-third appeared in the SAMJ. This support of local publications by an outstanding research scientist should serve as a shining example to others.

In 1980 Ralph became a member of the editorial board of the SAMJ, and he retained this and other more influential positions with the journal, and with publications subsequently added to the SAMA stable, for a period of 30 years!

The death of Steve Biko and the resulting shameful episode in the history of the SAMJ, which refused to publish some letters concerning his death, led to the much-publicised resignation from the Medical Association of South Africa (MASA) of several prominent medical people. Ralph's response was to get more actively involved in medico-political affairs through various organisations in order to influence change from the inside. His involvement, including his contributions to and through the journals and in senior and influential positions in SAMA, was ultimately recognised by his election as president of the South African Medical Association (SAMA), the successor body formed by the merger of MASA and several other opposition parties. During his presidency the signs of his final illness first became apparent.

CME

In 1981, when Ralph was elected to the MASA Board of Directors, he was also appointed as a member of the Publications Committee, the publisher of the SAMJ and other publications. At that time there was no compulsory requirement by the Professional Board that medical practitioners participate in continuing professional development (CPD). Then known as continuing medical education, this was voluntary, often in the form of refresher courses, and practitioners participated because it is a characteristic of professionals that they keep up to date in their professions. Niklaas Louw, the outgoing chairman of the Publications Committee, mooted the idea of a publication to assist practitioners in keeping up to date. I was sceptical about the viability of such an initiative, but Ralph took it on enthusiastically as the first voluntary editor of CME (Continuing Medical Education, then with the joint title of VMO - Voortgesette Mediese Onderrig). He laid down the principles that still guide CME 28 years later: each issue would cover a particular topic; topics must be of importance to the practice of medicine; papers must be comprehensive but simple and accessible to all practitioners; papers should be prepared by experts in the particular field; and each issue would have a guest editor to put together a team of contributors, preferably from across the country. Under Ralph's guidance CME was an instant and lasting success. However, it was nearly derailed when the next editor concentrated on contributors from his own faculty, increased the size of the journal beyond what was financially viable, and obtained a preponderance of papers in Afrikaans that resulted in a flight of advertisers. After this CME was brought under the control of the professional editors, where it has remained ever since. It is currently edited by Bridget Farham, with Ralph remaining on its Board until the end.

A leadership role

Ralph was elected chairman of the MASA Publications Committee in 1993 and also of its SAMA successors, ultimately the Health and Medical Publishing Group (HMPG), of which he remained chairman until just before his death.

During this period he played an important role in ensuring that the standards of the SAMJ were maintained. At a time when editorial capacity to adequately evaluate the scientific merit of submitted papers was lacking, Ralph happily took on the arduous task of 'scientific editor' for the SAMJ from 1986 to 1994. Thereafter he remained an active member of the 'hanging committee' that decided the fate of submissions - whether to accept, reject or, most frequently, to obtain referees' reports (the 'hanging committee' apparently derives its name from the committee of the Royal College of Physicians that decides where and which of its art collection to hang).

Political influences

Over this long period several major problems required wisdom and skill to negotiate, and Ralph was either a key person in dealing with these or a loyal supporter of changes that made sense.

The first was the ongoing influence of the then dominant political force that sought to continue political control of the SAMJ. Some embarrassing semi-authoritative policy-like statements that appeared in the journal resulted in the Publications Committee ruling that henceforth any material published in the SAMJ had to clearly identify its origin (at that stage, for example, editorials did not list the name of the author, although it was usually the editor). The important principle of editorial independence of the editors, whereby the editor is the final arbiter of what is published, was also strengthened.

The second major issue was that of the language of the publications. The SAMJ had a long tradition of publishing contributions in both English and in Afrikaans, and this was continued with CME. With time the number of scientific papers in Afrikaans presented for consideration for publication dwindled as authors increasingly wanted to be read internationally and an increasing number of foreign practitioners in South Africa could not understand Afrikaans. A rival Afrikaans-language journal had also been established. There was considerable political pressure on the Publications Committee to provide a language policy that clearly protected the position of Afrikaans. The various Publications Committees, perhaps wisely in hindsight, steered clear of a formal policy in this regard, but allowed the editors freedom to publish what they considered suitable. The editors in turn accepted on merit contributions in the then two official languages. Subsequently, editor Dan Ncayiyana published an editorial in Zulu to make a further point about the multi-lingual nature of South Africa, as recognised by our constitution. While occasional letters to the editor and obituaries are still published in Afrikaans, it no longer makes sense to publish scientific articles in anything other than English because of the international indexing of the SAMJ.

The business of publishing

Journal publishing has become a complex business fraught with dangers, compared with the days when the SAMJ was the only medical publication contender in the country.7 Principally because the SAMJ and its stable of publications now had to compete with dozens of medical publications for the same contributors and advertisers, and because the business model was archaic and ineffective, a new model was required.

Accordingly a business model of an independent company in partnership with an established successful publisher to improve critical mass in a highly competitive field was developed. Once Ralph had been persuaded of the wisdom of this approach, he became a tireless and effective campaigner to persuade and obtain the support of the SAMA Board and members. A particularly difficult concept for SAMA Board members to grasp and accept was that a valuable asset such as the journals and their CPD programmes could no longer be provided free of charge to members of the Association. Whatever annual deficit was shown by the HMPG should therefore not be considered as a loss but as a legitimate 'subscription' component towards receipt of journals as part of SAMA members' annual membership fees.

Ralph the person

Ralph retained the respect of colleagues of all political, religious and other persuasions by accepting them as valued colleagues even when he was at serious odds with them, particularly with those who supported apartheid (he later proudly announced his membership of the ANC whenever the opportunity arose, to the embarrassment of those who preferred a non-partisan approach). He retained genuine and polite relationships, always attacking the offending principle or policy, and not attacking the person.

Ralph was true to the principles that he considered to be correct and important, and was tireless and fearless in defending them.

Ralph was fanatical in ensuring the highest possible quality of our journals. He was critical of well-known academics who presented sloppy work for consideration, but on the other hand he was the perfect mentor for young first-time authors and would spend hours helping them to improve their offerings and persuading the editors to accept their material.

We celebrate Ralph's contributions to medical publications in South Africa. He was never in a paid post, but his influence nevertheless ranks with that of the pioneers and other greats in the long history of the SAMJ and its related journals. Like his other friends, we knew that we could count on his unstinting loyalty and support through the best and the worst of times. We miss his enthusiasm, vision, wisdom and mischievous sense of humour.